ABSTRACT

Objective

We hypothesised that providing evidence-based care to people presenting in crisis to three Emergency Departments and the 24/7 phone Psychiatric Triage Service in Victoria, Australia, would improve their clinical outcomes over time and experience of the adult mental health system. We tested this through a service prototype, the agile Psychological Medicine clinic.

Method

Descriptive statistics were used to understand the characteristics of people who presented in crisis. Patient journey maps were used to understand the impact of the system on the patient and assess whether they received the best clinical care over time. Insights from these analyses, and the evidence base, led to the development of the prototype. Using an open trial design, 194 patients received specialist treatment and effectiveness was measured through patient-reported outcome measures administered at initial and final appointments. Service utilisation was measured 12-months pre and post treatment.

Results

The agile Psychological Medicine clinic delivered value; outcomes significantly improved across psychological symptomology and behaviours. Reductions in emergency department presentations, phone triage calls and service costs resulted.

Conclusions

This innovative clinic demonstrated that access to front-end mental health treatment improves clinical outcomes, mitigates later complications and increases the prospects of keeping patients well over the longer term.

KEY POINTS

What is already known about this topic

(1) Hospital emergency departments (EDs) can often be the initial point of care for people seeking immediate help for mental health crises.

(2) Demand has increased, patient satisfaction has decreased and patients increasingly re-present in crisis.

(3) Therapeutic alliance has been shown to be a robust predictor of treatment outcome.

What this paper adds

(1) Mental health care could be improved for those presenting in situational crises by bringing evidence-based treatment with a consistent clinician with whom they could form a therapeutic alliance

(2) The agile Psychological Medicine clinic demonstrated that bringing specialist treatment to the front end of the system of care, improves clinical outcomes, mitigates later complications and increases the prospects of keeping patients well over the longer term.

(3) Patients who engaged in treatment had a 37% reduction in ED presentations 12 months after therapeutic intervention resulting in significant cost savings.

Abbreviations: aPM: agile Psychological Medicine; CATT: Crisis Assessment and Treatment Team; CBT: Cognitive behaviour therapy; CCT: Continuing Care Team; ECATT: Emergency Crisis Assessment and Treatment Team; ED: Emergency Department; PTS: Psychiatric Triage Service; SECASA: South Eastern Centre Against Sexual Assault

中文翻译：

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改善心理保健结果：敏捷心理医学诊所

摘要

客观的

我们假设向澳大利亚维多利亚州的三个急诊科和 24/7 电话精神病分诊服务中心提供基于证据的护理将随着时间的推移和成人心理健康系统的经验改善他们的临床结果。我们通过服务原型敏捷心理医学诊所对此进行了测试。

方法

描述性统计数据用于了解在危机中出现的人的特征。患者旅程地图用于了解系统对患者的影响，并评估他们是否随着时间的推移获得了最佳的临床护理。这些分析的见解和证据基础促成了原型的开发。使用开放试验设计，194 名患者接受了专科治疗，并通过在初始和最终预约时进行的患者报告结果测量来衡量有效性。在治疗前后 12 个月测量服务利用率。

结果

敏捷的心理医学诊所带来了价值；心理症状和行为的结果显着改善。减少了急诊科的介绍、电话分类和服务成本。

结论

这家创新诊所表明，获得前端心理健康治疗可以改善临床结果、减轻后期并发症并增加患者长期保持良好状态的前景。

关键点

关于这个主题的已知信息

(1) 医院急诊科 (ED) 通常可以成为寻求心理健康危机即时帮助的人的初始护理点。

(2) 需求增加，患者满意度下降，患者越来越多地再次出现危机。

(3) 治疗联盟已被证明是治疗结果的有力预测指标。

本文补充了什么

(1) 通过将循证治疗提供给一致的临床医生，可以改善那些在情境危机中出现的人的心理健康护理，他们可以与他们形成治疗联盟

(2) 敏捷的心理医学诊所表明，将专科治疗带到护理系统的前端，可以改善临床结果，减轻后期并发症，并增加患者长期保持良好状态的前景。

(3) 参与治疗的患者在治疗干预后 12 个月出现 ED 的情况减少了 37%，从而显着节省了成本。

缩写：aPM：敏捷心理医学；CATT：危机评估和治疗小组；CBT：认知行为疗法；CCT：持续护理团队；ECATT：紧急危机评估和治疗小组；ED：急诊科；PTS：精神病分诊服务；SECASA：东南反性侵犯中心